the appearance therein of ammonio-magnesian phosphate is not so directly a morbid product as is supposed, or as are the other substances I have mentioned. In the preceding conclusions I may have been anticipated, as we are told that "there is nothing new under the sun," and as a reference to the literature of the subject will show, but being the results of personal research, I offer them as a contribution to clinical medicine. Whether they confirm or correct previous observations I do not venture to assert; but I may be allowed the belief that to some it may be a new and useful lesson to be reminded that urinary deposits are to be met by the rules of healthy life, with plenty of ozone and oxygen, rather than by chemical solvents. Chronicle of Medical Science. REPORT ON SURGERY. BY EDWARD BELLAMY, F.R.C.S., Senior Assistant Surgeon to, Lecturer on Anatomy, and Teacher of Operative Surgery in, Charing Cross Hospital; Lecturer on Artistic Anatomy to the Science and Art Department, South Kensington. 1. Gillette.—Articular and Peri-articular Osteo-sarcoma and the difficulties of its Diagnosis. 2. MAURIAC.-Complete Syphilitic Atresia of Pharynx. 3. VERNEUIL.-Adhesion of free Border of Velum to Pharyngeal Walls. 4. BERGMANN.-Revolver Bullet Wound of Heart. Recovery. 5. WOOD.-Excision of Astragalus. 6. PERRIN.-Subastragaloid Amputation. 7. WOOD.-Treatment of Hypospadias. 8. BROWN.-Femoral Aneurism. 9. KOCHER.-Villous Cancer of Male Bladder. 10. ESMARSCH.-Treatment of Deep-seated Cysts of Neck. 11. MADELUNG.-On the method of production of fractures of Lower End of Humerus and Femur. 12. RIGAUD and BERGERON.-Treatment of Varicose Conditions of Superficial Veins. 13. MOSENGEIL.-Removal of Round-celled Sarcoma from Pharynx. 14. J. R. WOOD.-Treatment of Wounds by the Open Method. 15. OLLIER.-On the Treatment of Elephantiasis Nasi by Decor tication. 16. WOODBURY.-Strangulated Inguinal Hernia. 17. WULKOW.-Note of a Case of New Growth in the Navel. 1. Clinical Memoir on Osteo-sarcoma, Articular and Peri-articular, and the Difficulties of its Diagnosis. (Gillette, Bull. et Mém. de la Soc. de Chir. de Paris,' ii, 2, 1876).-The conclusions drawn by M. Gillette at the close of an elaborate article of this subject are as follows:-1. That the diagnosis of articular and peri-artieular osteo. sarcomas often offers, on account of their insidious progress, very great difficulties, since they may be confounded with osteo-periostitis or with white swellings. 2. If a white swelling has an unusual course, the surgeon should suspect it, and examine if the reunion of a certain number of phenomena which appear abnormal do not cause him to modify his diagnosis. 3. At the onset the diagnosis is almost impossible, the acute pain suggesting neuralgia, rheumatism, or commencing arthritis. 4. These cancerous joint diseases may appear like white swellings in youth, in lymphatic individuals, scrofulous, syphilitic, and their origin be referred, rightly or wrongly, to an injury. 5. Osteo-sarcoma may be suspected, and recognised by the continuous and rapid course taken by the affection, by the acute and persistent pain, in spite of rest and immobility, by the rapid development of the swelling and the special character the masses have, of pushing aside and lifting up the tissues, by the absence of suppuration, or at least by the little tendency these tumours have to suppurate, by their absolute resistance to therapeutic agents, and particularly by the increase of pain following compression, by the integrity of articular movements, which is due to the preservation of the diarthrodial surfaces, and by the absence of any anomalous position taken by the patient, as is the case in white swelling, and by the exploratory puncture. 6. The treatment consists in amputation high up or in disarticulation. 2. Complete Syphilitic Atresia of the Pharynx. (Gazette Méd. de Paris,' Mars 14, 1876.)-M. Mauriac, at the close of an interesting course of lectures on Pharyngo-nasal syphilosis, narrates a case, which from its extreme rarity, is worthy of publication. He states that up till the time of the termination of his lectures, no such case had presented itself to him. The patient, a man, æt. 33, had had an infecting chancre in 1864, followed by several severe attacks of pharyngeal syphilis. In 1865 he lost a considerable part of the velum palati, followed by complete adherence of the posterior wall of the pharynx to the remains of the velum and isthmus, cutting off all communication between the posterior nares and the bucco-pharyngeal cavity. The summary of the case in M. Mauriac's words is as follows:-"The anterior third or half of the velum was affected by the ulceration, and was united to the posterior wall of the pharynx, which was itself the seat of a considerable lesion, as a median cicatrix showed. The result of which was that the palatine arch was prolonged horizontally to the pharynx, and that a membranous diaphragm, formed by the débris of the velum, divided the pharyngeal canal into two parts, one superior, in which were the posterior nares and the Eustachian tubes, and an inferior or bucco-pharyngeal space. This inferior compartment, situated below the palatine diaphragm, was itself subdivided into two parts by an incomplete diaphragm, which was nothing more or less than a new isthmus faucium. It was in a plane directed obliquely backwards from the sides of the tongue to the pharynx, where it became united with the horizontal palatine diaphragm. This septum was formed below by the base of the tongue, and laterally by two large folds of the mucous membrane, which represented the anterior pillars, stretched, widened, and rendered immovable owing to their attachment to the pharynx. It was pierced at the centre, by a triangular opening, the apex of which corresponded with the middle portion of the posterior wall. The portion of the pharynx, situated above the isthmic diaphragm, is the posterior nares, that below, the pharynx, which communicated by the triangular opening, so that deglutition was not much hindered. This patient had been treated with iodide of potassium, and there appeared to be no antecedents of scrofula. M. Mauriac did not consider any surgical proceeding was indicated, indeed he thought that it would be worse than useless. 3. Adhesion of the Free Border and Postero-superior Aspect of the Velum Pendulum Palati and the Pharynx. (Proc. Soc. de Chirurg. de Paris,' Ap. 1876.)-M. Verneuil brought forward the following case. The patient was a young woman, married, 22 years of age, who had contracted syphilis since her marriage, and about a year afterwards had suffered great loss of substance of the soft palate, which resulted in a nasal tone of voice, and painful and imperfect deglutition. After a while the projection of the velum posteriorly became evident, and there were all the signs of closure of the posterior cavity of the nasal foss. The patient could not blow her nose, or breathe unless the mouth was open; she had intermittent deafness, and examination showed that the velum was completely fastened to the pharyngeal walls. M. Verneuil decided to operate, and proceeded thus-The patient was anesthetized, and the channel which remained between the pharynx and nasal fosse was enlarged by a knife, a pair of polypus forceps was then introduced, and their blades smartly opened, whilst the lateral adhesions were broken down by means of the fingers. He then placed between the velum and the pharynx an india-rubber apparatus, consisting of two lateral tubes, and of a series of transverse smaller ones, the anterior openings of the larger tubes passing out through the nostrils and the posterior by the mouth, opposite to the labial commissures, but it was found necessary to remove the instrument, as after some days specific ulceration showed itself wherever it was in contact. M. Verneuil had then recourse to progressive dilatation, by means of a sound ending in a caoutchouc bag, which was introduced by the nostrils and inflated; by repeating this proceeding daily it was hoped to prevent adhesions forming, but the negligence of the patient frustrated the perfection of the idea, nevertheless a sufficient aperture was formed, by means of which the patient could breathe and blow the nose, the sense of smell returned, and the nasal character of the voice was noticeable only during rapid utterance and in a loud tone. During the subsequent discussion M. Lucas-Championnière remarked that on a similar occasion he endeavoured to introduce a hollow sound from behind forwards, but after two hours' attempt, being unable to do so, he made lateral incisions to effect his object, but, notwithstanding the employment of india-rubber laminæ, adhesion still took place. At a second operation, he cut down with a single stroke into the nasal 205 foss behind the velum. The wound healed, but the patient has been forced to wear a silver tube through the nasal fossæ. As M. L.Championnière remarks very truly, surgery has not had its last word on this question, and until the problem is solved, it is indispensible to have recourse to appliances to prevent the production of these adhesions. 4. Revolver Bullet Wound of the Heart; recovery.-Dr. E. Anders describes the following case, which occurred in the Clinic of Prof. Bergmann, of Dorpat (Deutsche Zeitschr. f. Chir.,' vi, 1 and 2, p. 191, 1875). The diagnosis was arrived at on anatomical and physiological considerations, and the case, on account of its rarity, is of great interest. (G. Fischer, in his work on wounds of the heart, mentions only twelve cases.) A young man, in an attempt at suicide, shot himself in the region of the heart. After the original dyspnoea and hæmorrhage had ceased he was able to take the journey to Dorpat (fifteen miles). On admission the wound, which was round, about as large as a sixpence, was already scabbed over, corresponded exactly with the heart's impulse, and exhibited rhythmic pulsations. The temp. was 32.2° C., resp. 42; there was then dyspnoea, anxious expression, and vertigo. The area of the heart's dulness began at the upper edge of the third rib and extended to the edge of the sternum at the right side, and outwardly on the left to one centimètre above the line of the nipple. On the left side, behind and below there was dulness, no pectoral fremitus, but a pericardial friction sound at a circumscribed spot at the level of the fourth intercostal space. During the next two days the irritation of coughing was stronger, pulse frequent; evening temp. 39°. On the fourth day the dulness had risen on the posterior wall of the thorax, to the angle of the scapula, and in the upper zone there was pectoral fremitus and bronchial breathing, and the heart's dulness had extended outwards to one centimètre above the right edge of the sternum. There was pericardial exudation, and the left lung was the seat of pulmonary mischief. On the fifth day the pericardial exudation had increased outwards four centimètres over the right side of the sternum, and there was great sweating at night. From this time, however, the symptoms began to disappear. The exudations became absorbed rapidly and on the tenth day after the receipt of injury the heart's dulness reached only as far as the middle line of the thorax, and the pericardial rub had gone. Twenty days after the injury the wound had healed and its cicatrix moved synchronously with the systole. The examination of the lungs showed them to be tolerably normal and the absolute heart dulness reached only to a finger's breadth beyond the left edge of the sternum. The impulse during systole below the left nipple was clearly to be made out in the fourth intercostal space, and feeble in the fifth. The first sound was divided, this symptom was weakest over the aorta, and ceased in the recumbent position. The point of pathological importance in this case is the behaviour of the heart's beat. Anomalous conditions of the circulation were not observed, and thus a perforation of the walls of the heart, with escape |